Squealing tires, breaking glass and sirens. A sick, screaming baby at 3 a.m.

Lack of health insurance in these situations can cause one to hear the voice of a bill collector on the phone later.

Wednesday, Mark Rukavina, executive director of the Access Project, a resource center affiliated with Brandeis University, along with several health care professionals released the results of a report titled, "Paying for Health Care When You're Uninsured: How Much Support Does the Safety Net Offer?"

In this survey of 6,884 uninsured Americans, the results showed that most who receive medical care have enormous difficulty affording care, even at institutions with a mission to provide services to the poor and uninsured. Interviews were conducted in 18 states which included Ohio, Kentucky and West Virginia.

This situation is the reality for more than 40 million Americans who have no health insurance. Because of job losses, the number is increasing. Even those who have a job are sometimes paying higher premiums.

"If you're suddenly diagnosed with severe diabetes or cancer, you have to get charity care or die. It's awful." Kathy Lee, medical outreach supervisor for the Ironton-Lawrence County CAO, said.

Lee told the story about one person she has encountered who needs a $65,000 back surgery. The person was told to pay $10,000 up front, she said. A physician had offered to do the surgery as a charity case, but the hospital had refused.

"Who has $10,000?" Lee said. "That person is suffering from additional complications that will raise their costs even more."

In some situations, she said, concerns about cost will sometimes discourage people from getting care they need. Unpaid medical bills can also ruin credit. During a Wednesday audio press conference, a West Virginia woman plagued with medical debt said she could not even get credit to purchase a radio.

WHAT RESOURCES ARE AVAILABLE?

In Lawrence County, Lee said the CAO family medical centers provide sliding fees, meaning that the patient's bill is based on his/her income. Bills can be as little as $9, she said. Also, they offer assistance in getting certain prescription drugs.

The centers in Ironton, South Point, Chesapeake and Coal Grove see 20-30 patients a day, Lee said. Every center except for the one in Coal Grove also offer quick care hours in the late afternoon and evening hours. The South Point and Ironton centers have Saturday hours.

Since January 2001, Lee said the Lawrence County office of the Ohio Department of Job and Family Services has received 1,216 applications for the Children's Health Insurance Program through Healthy Start/Healthy Families. Not everyone who applies qualifies, but anyone with children from birth to age 18 can submit applications. No face-to-face interviews are required, but the department needs four to six weeks for income verification.

"It can be a difficult decision, but some people need to swallow their pride and get health insurance for their children," Lee said, also adding that the program is available to people who do not qualify for cash assistance or food stamps.

With no hospital in Lawrence County, residents either have to drive to Portsmouth or Gallipolis for more serious medical problems or go to Kentucky and West Virginia.

Driving that far can be impossible for someone without reliable transportation or inconvenient, Lee said.

"We are a non-profit medical center, and ability to pay is not a factor," Julie Marsh, public relations specialist with King's Daughters Medical Center said. "Southern Ohio is an important market for us."

At KDMC, Marsh said employees will work with patients to devise a reasonable payment plan, and those meeting certain income guidelines may be able to have entire bills written off as charity cases. The hospital offers free health screenings for high blood pressure, cancer and other health problems.

St. Mary's Medical Center provided $5 million in charity care, according to a prepared statement. The figure also includes inpatient charity care for qualified patients.

Cabell-Huntington Hospital offers assistance through the Chamberlin and Edmonds program whose staff members help uninsured patients apply for charity assistance, Chris Maniskas, director of social work, said. The hospital can also help patients get assistance through the Hill-Burton program of the U.S. Department of Health and Human Services, she said.

Our Lady of Bellefonte Hospital also offers charity care programs and sliding scale. A person with a $19,000 income with one child may, in some instances, pay only $32, regardless of the size of a hospital bill, Mike Wirzfeld, director of financial services said.

"All the time, we're in people's rooms when they say, 'I need this test. Can you help me?" he said. "Ignoring it or not affording it is not going to make it go away. We help them out."

The office also assists Ohio residents in applying for Medicaid, Wirzfeld said.

However, Wirzfeld and Maniskas both acknowledged that some forms of assistance at their hospitals are only for Kentucky and West Virginia residents.

WHAT IF YOU ARE NOT ELIGIBLE?

Even with charity care programs available at many medical facilities, Lee said many working but still uninsured people will still make too much money to qualify for assistance, even if they are working a low-paying job.

"The working man falls through the crack," she said.

Lee suggested the possibility of the United States adopting a single-payer system, which has been put into practice in Canada. Through taxation, consumers are almost insulated from the cost of health care.

"If we were to go to a socialistic system, people would think it was communism," she said. "It's not. I would pay more if I got health care, and most taxpayers probably would."

The population between birth and age 18 qualify for CHIP, and the 65 and older population qualify for Medicare.

"People between 19 and 64 are left out in the cold," she said.

However, Lee said those people, the vast majority of the population, are also legal voting age.

If people do not write or call representatives at the state and national level and the governor, Lee said, those officials will not do anything.

Tuesday, Lee is expected to receive a federal petition for those wanting to get more help for the uninsured and underinsured.

Lawrence County needs at least 32 signatures from legally registered voters. Lee advised calling 534-1714 first if anyone is interested because the signature has to be witnessed.

"We need to have an uprising," she said. "If we remain passive, nothing is going to get done. The ball is in our court. The wheel that squeaks the loudest gets the oil."